Therapeutic dilemmas in the management of thyroid cancer with laryngotracheal involvement

Invasion of the larynx and trachea by thyroid cancer is an uncommon but dif ficult problem. Them is no consensus on indication for or extent of surgery , particularly when there is a requirement for airway reconstruction. From 1989 through 1996, we treated 22 patients with thyroid carcinoma with invas ion of the larynx and trachea. Seventeen of these patients had recurrent di sease. We applied radioactive iodine therapy after regional ablative surger y to resectable tumors with or without lung metastasis, larynx-preserving s urgery to extraluminal or small intraluminal tumors restricted to the short segment of trachea, or total laryngectomy to recurrent tumors deeply invad ing the cartilage framework of the larynx. We performed arytenoid adduction or thyroplasty in one stage if the recurrent laryngeal nerve was paralyzed or resected intraoperatively. We could get relatively good survival and fu nctional results by aggressive surgical treatment in 20 patients, but the d isease was inoperable in 2 patients. It is stressed that head and neck surg eons who have to deal with cancer of the thyroid should not only be familia r with various techniques of airway reconstruction and voice rehabilitation but also must be aware of the biologic behavior of the thyroid carcinoma.